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1.
Duodenal perforations after laparoscopic cholecystectomies are rarely reported. The aim of this study is to focus on this
complication and to suggest ways to reduce its occurrence and avoid diagnostic mistakes and therapeutical delays that could
be fatal. We reviewed four personal cases and a number of others reported in the literature. Duodenal perforations are caused
by improper use of the irrigator-aspirator device when retracting the duodenum, or by electrosurgical and laser burns. A duodenal
perforation should be suspected in cases of bile leakage, peritonitis, intraabdominal or retroperitoneal collections, high
serum or drainage amylase concentration, absence of bile leakage from the biliary tree, and the existence of a retroduodenal
mass. Diagnosis requires a gastrografin upper GI series. Differential diagnosis is mainly with biliary lesions and other causes
of peritonitis. Relaparoscopy may require intraoperative upper GI endoscopy or Kocher's duodenal mobilization to detect the
perforation. Early diagnosis allows primary repair, usually by laparoscopy. Perforations of the duodenal cap are easier to
diagnose and have a better prognosis than those of the descending duodenum. A lumbar abscess is a frequent complication.
Received: 27 May 1998/Accepted: 14 September 1998 相似文献
2.
Laparoscopic treatment of congenital choledochal cyst 总被引:11,自引:0,他引:11
We describe the laparoscopic treatment of a patient presenting with congenital choledochal cyst. Our patient was a 19-year-old
man with a complaint of recurrent abdominal pain due to pancreatitis. The choledochal cyst was type I and had a common channel
of pancreatobiliary duct, as revealed by endoscopic retrograde cholangiopancreatography. Under laparoscopic guidance, the
dilated bile duct and the gallbladder were excised, and a Roux-en-Y anastomosis was constructed with an endo-EEA. Finally,
end-to-side anastomosis was carried out by the continuous suture method, aided by an Endostitch between the stump of the hepatic
duct and the Roux-en-Y limb. After the operation, slight hyperamylasemia was observed for several days but further treatment
was not necessary. Postoperative symptoms were minimal, and the patient was discharged on the 11th day after the procedure.
Although it is difficult and time-consuming, laparoscopic operation is highly beneficial for the patient. The use of such
instruments as the endostapler and Endostitch may help to simplify this complex intracorporeal procedure involving division
and anastomosis of the digestive tract.
Received: 7 March 1997/Accepted: 11 April 1997 相似文献
3.
A 46-year-old man with epigastralgia and slight elevation of urinary 5-hydroxyindole acetic acid (5HIAA) was found to have
a well-demarcated carcinoid tumor in the duodenal bulb. The tumor measured 8 mm in size, and showed submucosal involvement
but no metastasis to the liver and regional lymph nodes. After laparoscopic exposure and lifting of the duodenal wall around
the tumor, wedge resection of the duodenal bulb including the tumor was performed successfully with a laparoscopic endostapler
under direct endoscopic control. The postoperative course of the patient was uneventful. Laparoscopic wedge resection of the
duodenum would be an appropriate minimally invasive treatment for selected duodenal neoplasms with special preoperative assessments
and intraoperative considerations.
Received: 27 January 1997/Accepted: 4 December 1997 相似文献
4.
Background: The laparoscopic approach must be shown to be cost-effective as well as safe and technically effective before being widely
adopted. A review of 54 consecutive patients who underwent open and laparoscopic colposuspension is presented and a cost-analysis
is performed comparing the two approaches.
Methods: This study was a retrospective controlled review of patient records and accounts of in-hospital costs incurred at a private
hospital.
Results: Theater costs were significantly greater in the laparoscopic group but this was balanced by a shorter length of stay and
subsequent reduced accommodation cost. There was no difference in the overall in-hospital costs between the two groups.
Conclusion: The laparoscopic surgical approach is safe and effective and by no means more expensive than the open approach. In the future,
the laparoscopic approach can only become more cost efficient; techniques will improve and there will be earlier returns to
work and, subsequently, greater productivity.
Received: 19 August 1996/Accepted: 20 December 1996 相似文献
5.
M. Miyahara S. Kitano K. Shimoda T. Bandoh K. Chikuba S. Maeo M. Kobayashi 《Surgical endoscopy》1996,10(3):352-353
A patient who sustained a colonic perforation during therapeutic colonoscopy was treated successfully by laparoscopic repair. Laparoscopy was performed 5 h after polypectomy. Fecal matter was not identified in the peritoneal cavity. Local peritonitis was mild. The laceration was oversewn with five sutures using the extracorporeal endoscopic knot technique. The appendix epiploica was then anchored over the lesion. The postoperative recovery was rapid and uneventful. Laparoscopic surgery may become a useful tool for the safe, effective, and minimally invasive management of iatrogenic colonic perforation. 相似文献
6.
Background: One of the etiologies of pelvic pain in women, often unrecognized, is the Masters-Allen syndrome, which was described in
1955 as the ``universal joint cervix' syndrome. It has the following three elements: (1) etiology: obstetrics-related trauma;
(2) clinical findings: uterine retroversion with hypermobile cervix following elongation or desinsertion of the uterosacral
ligaments; (3) anatomy: visualization of a tearing of the posterior serosa and subperitoneal fascia of the ligamentum latum.
Methods: Forty-one laparoscopic Douglasectomies with uterosacral ligamentopexy were performed in the department of Gynecology at the
University Hospital of Caen during the period between 1990 and 1995 in patients with painful retroverted uterus. The patient
selection was made thanks to the ``pessary test.' The surgical endoscopic procedure, identical to the operation first promoted
by Jamain and Letessier in 1976 by laparotomy, is described.
Results: Total pain relief was experienced by 31 patients (75%) and partial relief by five patients (5%). Two main complications occurred,
requiring one laparotomy (bleeding from a pelvic varicose vein with a concomitantly occurring breakdown of the washing-aspiration
system) and one second laparoscopy at day 15 (one case of hematoma below the peritonization revealed by pain). Twenty-three
women became pregnant again, and had normal deliveries except for two cesareans, with no recurrence of pain. Douglasectomy
is compared to alternative techniques in the literature. Other indications for Douglasectomy are discussed.
Conclusion: Douglasectomy is the only definitive procedure for restoring normal anatomy of the pelvic floor in case of painful uterine
retroversion occurring in a setting of Masters-Allen syndrome. Additionally, it provides for pathological analysis of the
excised peritoneum. The results of this procedure are excellent when the indication is correctly set, particularly as concerns
positive pessary testing.
Received: 22 April 1996/Accepted: 15 July 1996 相似文献
7.
Reardon PR Scarborough T Matthews B Preciado A Marti JL Brunicardi FC 《Surgical endoscopy》2000,14(3):298-299
Passing the stomach behind the esophagus during laparoscopic Nissen fundoplication is a common source of frustration for
the laparoscopic surgeon. It often leads to an incorrect formation of the fundoplication, resulting in a wrapping or twisting
of the fundus around the distal esophagus. The correct technique should result in the distal esophagus being enveloped inside
the fundus without distorting the orientation of the greater curve. We have developed an easy, precise, and reproducible technique
to perform this maneuver. The steps for performance of this maneuver are described.
Received: 12 March 1999/Accepted: 24 September 1999 相似文献
8.
The safety and effectiveness of laparoscopic treatment for incarcerated inguinal hernia have not been clarified. Six patients
who underwent laparoscopic reduction and repair of incarcerated inguinal hernias were reviewed retrospectively. All operations
were initiated within 1 h after establishment of the diagnosis. Laparoscopically, the incarcerated small-bowel segments could
be easily returned to the abdominal cavity by a combination of pulling them with Babcock forceps while pushing back the bowels
from outside the abdominal wall. The hernial portals were not cut in three patients, while they were dissected in the other
three. All incarcerated bowels were congested and red immediately after reduction; however, their color returned to normal
during hernia repair and unnecessary bowel resection was therefore avoided. The mean operation time was 88 min. Although one
patient underwent laparotomy because of the suspicion of necrosis of the incarcerated inguinal hernia, which was finally found
to be due to postoperative paralytic ileus, the postoperative courses of the remaining five were uneventful. Laparoscopic
reduction and repair of incarcerated inguinal hernia was useful, and unnecessary bowel resection could be avoided.
Received: 9 February 1996/Accepted: 20 May 1996 相似文献
9.
Laparoscopic surgery during pregnancy 总被引:5,自引:3,他引:2
Background: Laparoscopic surgery is known for its many advantages, but the use of this modality during pregnancy is still under discussion.
Methods: The subjects in this discussion are the unknown influence of the pneumoperitoneum and the fear of damaging the uterus while
inserting the Veress needle and trocars. In a review of recent literature describing laparoscopic surgery during pregnancy,
no complications were seen. We performed four laparoscopic appendectomies and three laparoscopic cholecystectomies between
12 and 33 weeks estimated gestational age (EGA).
Results: All pregnancies passed without complications and ended in at-term deliveries of healthy babies.
Conclusions: The risks, precautions to avoid them, and the safety of laparoscopic surgery during pregnancy are discussed in the light
of our experience and reports in recent literature.
Received: 26 September 1995/Accepted 3 May 1996 相似文献
10.
N. Kathouda S. Wattanasirichaigoon E. Tang P. Yassini U. Ngaorungsri 《Surgical endoscopy》1997,11(3):257-260
Background: Lumbar sympathectomy retains a role in the treatment of patients with causalgia, Symptomatic vasospasm, and nonreconstructable
arterial occlusive disease. Open surgical sympathectomy, with its attendant morbidities, remains the standard. Chemical sympathectomy
has been introduced as a less invasive means of achieving sympatholysis. However, this has been associated with incomplete
and transient denervation.
Methods: We present a series of five lumbar sympathectomies performed laparoscopically.
Results: All patients sustained symptomatic relief and no postoperative complications were noted. Postoperative skin thermometry and
resistance measurements confirmed adequacy of sympatholysis.
Conclusion: We conclude that lumbar sympathectomy can be performed laparoscopically. Our preferred technique is now the extraperitoneal
approach. Such an approach combines the durability and reliability of standard open sympathectomy with the minimal invasiveness
of laparoscopic surgery. 相似文献
11.
Laparoscopic rectopexy according to Wells 总被引:4,自引:0,他引:4
Background: The laparoscopic approach usually reduces the morbidity of procedures performed by laparotomy. The aim of this study was
to demonstrate the usefulness of laparoscopic rectopexy.
Methods: A total of 37 patients were included in this prospective study. The indication was true rectal prolapse in all patients.
Incontinence was seen in 33% of the patients. A slightly modified Wells procedure was performed laparoscopically. Postoperatively,
the patients were evaluated for resolution of the prolapse and incontinence. They were also questioned about their satisfaction
with the procedure.
Results: Laparoscopy was successful in all but one case. Follow-up is available in 32 of 37 patients. Prolapse was cured in all patients,
and the incontinence resolved in 11 of 12. In addition, 38% of the patients experienced significant constipation preoperatively
versus 5% postoperatively.
Received: 22 January/Accepted: 7 May 1998 相似文献
12.
Laparoscopic repair of perforated duodenal ulcer 总被引:5,自引:2,他引:3
M. L. Druart R. Van Hee J. Etienne G. B. Cadière J. F. Gigot M. Legrand J. M. Limbosch B. Navez M. Tugilimana E. Van Vyve L. Vereecken E. Wibin J. P. Yvergneaux 《Surgical endoscopy》1997,11(10):1017-1020
Background: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The
feasibility of the laparoscopic repair was evaluated.
Methods: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary
in eight patients. The morbidity rate was 9% and mortality rate 5%.
Results: The mean delay of postoperative gastric aspiration (mean 3.4 days) and resumed food intake (mean 4.4 days) as well as the
mean postoperative hospital stay (mean 9.3 days) were comparable to conventional surgery, but postoperative comfort was subjectively
increased by laparoscopy and noticed by all laparoscopic surgeons participating in this study.
Conclusions: Laparoscopic repair of perforated peptic ulcer proves to be technically feasable and carries an acceptable morbidity and
mortality rate, compared with conventional surgery.
Received: 16 August 1996/Accepted: 1 April 1997 相似文献
13.
Laparoscopic colectomy 总被引:4,自引:1,他引:3
G. A. Fielding J. Lumley L. Nathanson P. Hewitt M. Rhodes R. Stitz 《Surgical endoscopy》1997,11(7):745-749
Background: Laparoscopic colectomy has developed with the explosion of technology that has followed laparoscopic cholecystectomy. Accumulation
of skills in general laparoscopic surgery has made complex surgery, such as colectomy, feasible.
Methods: Three hundred fifty-nine laparoscopic cases were prospectively studied. Data has been kept on benign and malignant cases,
operative results, hospital stay, and morbidity. Special care has been taken to follow malignant cases, looking for recurrence
of disease.
Results: There were 359 cases (206 females, 153 male) average age 58.8 years (18–94), and 149 patients had malignancy. All types of
resections were performed, including 151 anterior resections, 66 right hemicolectomies (RHC), 36 total colectomies, and 22
rectopexies. Operating times fell with experience—the last 20 cases of anterior resection took 150 min (110–240) and of RHC
took 130 min (65–210). Twenty-six (7%) cases were converted to open surgery. Hospital stays for anterior resection lasted
5–7 days (2–33); in the last 20 cases the average stay was 4 days. Morbidity included seven leaks (2.7%), four strictures
(1.2%), 12 wound infections (3.3%), and nine ileus (2.5%). There were six deaths within 30 days—sepsis, myocardial infarction,
aspiration pneumonia, and disseminated liver metastases. One hundred forty-nine cancer cases have had ten recurrences: one
pelvic recurrence, six liver metastases, two para-aortic nodal, and one case of disseminated disease. Average time of recurrence
was 33 months (15–46 months).
Conclusions: Laparoscopy in the hands of experienced laparoscopic surgeons is a safe, efficient procedure. All types of procedures are
possible. Early results in 149 malignancies are encouraging and recurrence rates are low. Prospective studies, now that skills
are developed to a level comparable to that of open surgery, are now being performed to further assess laparoscopy's possible
role in treating cancer.
Received: 26 March 1996/Accepted: 15 October 1996 相似文献
14.
Laparoscopic ultrasonography during laparoscopic cholecystectomy 总被引:3,自引:0,他引:3
Background: This study assessed the effectiveness of laparoscopic ultrasonography in demonstrating biliary anatomy, confirming suspected
pathology, and detecting unsuspected pathology.
Methods: Laparoscopic ultrasonography was performed on 48 patients (17 M:31 M) who underwent laparoscopic cholecystectomy. An Aloka
7.5-MHz linear laparoscopic ultrasound transducer was used for scanning.
Results: Gallbladder stones were confirmed by laparoscopic ultrasonography in all patients and unsuspected pathology was found in
five patients. Two patients were found to have common bile duct stones by laparoscopic ultrasonography and this was confirmed
by laparoscopic cholangiography. Laparoscopic ultrasound was found to be helpful during dissection in four patients, particularly
in a patient with Mirizzi syndrome. The entire common bile duct was visualized by laparoscopic ultrasonography in 40 patients
but was poorly seen in eight patients. The mean time taken for the examination was 9 min (range 4–18 min).
Conclusion: Laparoscopic ultrasound is useful during laparoscopic cholecystectomy.
Received: 8 November 1995/Accepted: 5 May 1996 相似文献
15.
Poddoubnyĭ IV Dronov AF Kovarskiĭ SL Korznikova IN Darenkov IA Zalikhin DV 《Surgical endoscopy》2000,14(12):1107-1109
Background: The technique of the laparoscopic treatment of varicocele in children is described, and its outcome is discussed.
Methods: A total of 180 patients from 6 to 14 years of age were studied. All of them had left-sided varicocele; 10 of them were recurrences
after treatment by other methods. Varicocele was diagnosed on physical examination and confirmed by Doppler ultrasonography.
The laparoscopic procedure included obligatory dissection and preservation of the spermatic artery and tinted lymphatic vessels,
followed by double ligation of the spermatic veins.
Results: There were no intraoperative or postoperative complications and only one case of recurrence (0.6%).
Conclusion: The suggested technique for laparoscopic varix ligation is a highly effective and reliable method for the treatment of pediatric
varicocele. It provides the minimal invasiveness of the approach, effective microsurgical quality of visualization, and dissection
with guaranteed preservation of the spermatic artery and lymphatic vessels, along with very low rates of complication and
recurrence.
Received: 2 February 1999/Accepted: 7 October 1999/Online publication: 29 August 2000 相似文献
16.
M. E. Allaf S. V. Jackman P. G. Schulam J. A. Cadeddu B. R. Lee R. G. Moore L. R. Kavoussi 《Surgical endoscopy》1998,12(12):1415-1418
Background: In order for robotic devices to be introduced successfully into surgical practice, the development of transparent surgeon/machine
interfaces is critical.
Methods: This study evaluated the standard foot pedal for the AESOP robot compared to a voice control interface. Speed, accuracy,
learning curves, durability of learning at 2 weeks, and operator-interface failures were analyzed in an ex vivo model.
Results: Foot control was faster and had less operator-interface failures. Voice control was more accurate as measured by ``pass points.'
The foot control learning curve reached a plateau at the third trial, while the voice control did not fully plateau. Durability
of learning favored the foot control but was not significantly different.
Conclusions: Currently, the voice control is more accurate and has the advantage of not requiring the surgeon to look away from the operative
field. However, it is slower and may require more attention as an interface. As voice recognition software continues to advance,
speed and transparency are anticipated to improve.
Received: 24 October 1997/Accepted: 2 February 1998 相似文献
17.
Laparoscopic treatment of ventral hernia 总被引:3,自引:0,他引:3
Farrakha M 《Surgical endoscopy》2000,14(12):1156-1158
Laparoscopic repair of abdominal wall hernias has been introduced recently to treat both spontaneous and incisional hernias
with reported good results. In the Mafraq and Al Jaziera Hospitals in the United Arab Emirates, 18 patients have been treated
using the laparoscopic technique. These cases included 11 incisional hernias, 5 spontaneous paraumbilical hernias, and 2 combined
incisional and paraumbilical hernias. A bilayer repair was performed in all cases using a layer of polyester mesh to bridge
the defect and a sheet of Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ, USA) to prevent adhesions between first layer
and the bowel. Seroma at the hernia site was the most frequent postoperative complication. Hospital stay ranged from 2 to
7 days (mean, 3.2 days). Recurrent hernia developed in one patient after a mean follow up of 22.3 months. This technique is
in its evolution. Long follow-up evaluation is required before the effect on recurrence is known, and further development
regarding the composition of prosthetic biomaterials and the methods of its fixation is expected.
Received: 4 February 2000/Accepted: 11 May 2000/Online publication: 28 September 2000 相似文献
18.
Laparoscopic management of acute cholecystitis 总被引:2,自引:1,他引:1
A. Bickel A. Rappaport V. Kanievski I. Vaksman M. Haj N. Geron A. Eitan 《Surgical endoscopy》1996,10(11):1045-1049
Background: Laparoscopic cholecystectomy for acute cholecystitis is considered feasible and safe, but it is associated with a higher
rate of conversion to laparotomy than elective cholecystectomy because of technical reasons and anatomical changes related
to the inflammatory process. The value of several factors that might influence its successful completion has not been studied
completely yet, including the role of residents in operating such cases under attending-surgeon surveillance.
Methods: In a retrospective nonrandomized study, the medical charts of 182 patients that were operated for acute cholecystitis (94
of whom via the laparoscopic approach) were studied. The study was also conducted to study the effect of residents as operators.
Results: Male sex, duration of right upper abdominal pain, and the severity of the inflammatory process have all been significantly
and independently correlated with increased conversion rate to laparotomy. Operation time was not longer than that of the
open approach, and hospital stay and complication rate were lower. Operations performed by residents were associated with
twofold conversion rate to laparotomy, without increased complication rate (p < 0.012).
Conclusions: Laparoscopic management of acute cholecystitis is feasible and safe. Considering the factors discussed above, lowering the
threshold for conversion is necessary in selected cases to maintain low morbidity rate. Integrating laparoscopic cholecystectomy
for acute cholecystitis into surgical residency should be studied.
Received 5 January 1996/Accepted 22 April 1996 相似文献
19.
Laparoscopic enucleation of a solitary pancreatic insulinoma 总被引:7,自引:1,他引:6
Insulinomas are usually small, benign tumors of the pancreas, often found in obese patients, which require an incision that
is out of all proportion to the size of the lesion. A laparoscopic technique for enucleation of a pancreatic insulinoma is
described.
Received: 4 October 1994/Accepted: 18 September 1995 相似文献
20.
Laparoscopic removal of a swallowed toothbrush 总被引:1,自引:1,他引:0
Toothbrush swallowing is an uncommon occurrence. Unlike most cases of foreign-body ingestion, there have been no cases of
spontaneous passage reported. Consequently, prompt removal is recommended before complications develop. We report a case of
toothbrush ingestion which failed attempted endoscopic removal. This patient was managed successfully with laparoscopic assisted
removal via gastrotomy. We recommend this approach for the removal of any ingested foreign bodies when surgical intervention
is indicated.
Received: 20 December 1995/Accepted: 1 March 1996 相似文献